Pharmacological Interventions

As part of a broader approach to treatment, the use of pharmacological agents
on a voluntary basis may be helpful adjuncts to treatment for some sexually
abusive individuals. For example, adults or juveniles who experience cooccurring
psychiatric conditions such as anxiety, depression, thought disorders, or attention–deficit
hyperactivity disorder may not respond as effectively to interventions because
of interfering symptoms. These types of mental health issues tend not to be
underlying factors that lead to sex offending and they are generally not related
to sexual recidivism (Hanson & Morton–Bourgon, 2005). Rather, these
symptoms are potential responsivity factors, and medication intervention is
designed to reduce symptoms and increase functional status so that individuals
are better able to participate in and benefit from the treatment process.

For other individuals, however, pharmacological interventions may be necessary
to manage psychiatric disorders that are more closely linked to offending.
Specifically, some adults and juveniles experience recurring and intense sexual
drives and urges (e.g., paraphilias) that exacerbate or even fuel sex offending
behaviors. In these instances, medications such as antiandrogens or other hormonal
agents can reduce the intensity and/or frequency of sexual drives, urges, preoccupations,
or compulsions that have not responded sufficiently to behavioral or cognitive–behavioral
interventions (Berlin, 2000; Bradford & Fedoroff, 2006; Glaser, 2003; Grubin,
2000; Kafka, 2001; Kafka & Hennen, 2002). Recent research indicates that
the use of hormonal agents is associated with recidivism reductions among sex
offenders (Lösel & Schmucker, 2005; MacKenzie, 2006), although other
research has raised questions about their use (Hanson & Harris, 2000).

The use of selective serotonin reuptake inhibitors (SSRIs) can be beneficial
when treating some sex offenders, particularly those with co–occurring
mood, anxiety, or impulse–control disorders. This is because SSRIs not
only lessen symptoms of those disorders, but also have common side effects
such as reduced sexual drives and urges (AACAP, 1999; Berlin, 2000; Bradford & Fedoroff,
2006; Bradford & Greenberg, 1998; Greenberg & Bradford, 1997; Grubin,
2000; Sheerin, 2004).

The primary goal of pharmacological interventions is to assist offenders with
gaining control over problematic sexual drives, urges, and behaviors—not
to eliminate sexual behaviors altogether (Bradford & Greenberg, 1998;
Laws & O’Donohue, 1997). The use of pharmacological interventions
is not without controversy; questions exist regarding the potential range of
side effects, the provision of informed consent with often involuntary clients,
and the failure to use these agents as part of a more comprehensive and integrated
treatment strategy (Glaser, 2003). Some experts argue that neither the positive
benefits nor negative side effects of hormonal agents are understood fully
(Glaser, 2003; Sheerin, 2004). Moreover, none of the classes of pharmacological
agents has been sanctioned for use in the treatment of sexual deviance by the
respective regulatory bodies in the United States, Canada, United Kingdom,
or most other Western countries (Bradford & Fedoroff, 2006).

Pharmacological interventions with juvenile sex offenders should be utilized
judiciously (Hunter & Lexier, 1998; Morenz & Becker, 1995). While the
use of psychotropic medications to ameliorate symptoms of common disorders
of justice–involved youth (e.g., attention–deficit hyperactivity
disorder, anxiety and depressive disorders) is less controversial, the appropriateness
of antiandrogens and hormonal agents continues to be very questionable with
juvenile sex offenders except in extreme cases (AACAP, 1999; Bradford & Fedoroff,
2006; Hunter & Lexier, 1998). Because of the potential additive value under
limited circumstances, some pharmacological interventions may be appropriate
when included as part of a broader treatment regimen for certain juveniles
who have committed sex offenses—namely older, more impulsive youth, and
those who clearly evidence symptoms of paraphilic disorders (Bradford & Fedoroff,
2006; Hunter & Lexier, 1998; Sheerin, 2004). And despite the promise of
SSRIs, the

U.S. Food and Drug Administration, the federal oversight agency in the United
States that is responsible for regulating medications, recently warned about
their overall use with adolescents because of the increased potential for increased
self–harm and aggression toward others (U.S. Food and Drug Administration,
2004). Further research is clearly needed. In the meantime, careful risks–benefits
analyses must be conducted before using pharmacological agents with juveniles,
and close monitoring by qualified and experienced medical professionals is
required in the event that such medications are deemed necessary (Bradford & Fedoroff,
2006; CSOM, 1999; Hunter & Lexier, 1998).

When pharmacological interventions are warranted, it is important that the
medical or psychiatric professionals providing care to sex offenders work collaboratively
with the other professionals involved in the sex offender management process.
In so doing, supervision and offense–specific treatment providers can
become better educated about potential benefits and limitations of these interventions
and can also assist medical professionals with monitoring critical issues such
as potential side effects and medication non–compliance. Furthermore,
collaboration ensures that pharmacological agents are not used as the exclusive
mode of treatment; rather, such interventions should be used to complement
and enhance offense–specific treatment and treatment (Berlin, 2000; Bradford & Greenberg,
1998; Grubin, 2000; Laws & O’Donohue, 1997).